Attachment__6_-__Past_Performance_Questionnaire.pdf

FA5270-19-Q-003C

Attachment 6

Past Performance Questionnaire

PAST PERFORMANCE QUESTIONNAIRE

CONTRACT INFORMATION (Contractor to complete Blocks 1-4)

1. Contractor Information Company Name: CAGE Code:

Address: DUNs Number:

Phone number:

Email Address:

Point of Contact: Contact Phone Number:

2. Work Performed as: Prime Contractor / Sub Contractor / Joint Venture / Other

Percent of project work performed:

If subcontractor, who was the prime (Name/Phone #):

3. Contract/Project Information Contract Number:

Delivery/Task Order Number (if applicable):

Contract Type:

Contract Title/Name:

Contract Location:

Award Date (mm/dd/yy):

Contract Completion Date (mm/dd/yy):

Contract Price (Award Amount):

4. Project Description:

Complexity of Work High Med Routine How is this project relevant to project of submission? (Please provide details such as similar equipment, requirements, conditions, etc.)

CLIENT INFORMATION

5. Client Information Name:

Title:

Phone Number:

Email Address:

RATINGS AND DEFINITIONS

評価基準と定義

PLEASE CIRCLE THE ADJECTIVE RATING WHICH BEST REFLECTS

YOUR EVALUATION OF THE CONTRACTOR’S PERFORMANCE.

該当する評価基準に○を付けて下さい。

1. QUALITY（仕事の質） :

a) Quality of technical data/report preparation efforts (including design documents) 技術データやレポートの質はよかったか？ E VG S M U N

(E) Exceptional 特に優れている

Performance meets contractual requirements and exceeds many to the Government/Owner’s benefit.

The contractual performance of the element being assessed was accomplished with few minor problems and corrective actions were highly effective. 仕事が契約内容と合致しており、顧

客の希望を上回る点が多い。微妙な不具合も

契約の内容に修正し非常に満足な結果であ

る。

An Exceptional rating is appropriate when the Contractor successfully performed multiple significant events that were of benefit to the Government/Owner. There should have been NO significant weaknesses identified.

(VG) Very Good 優れている

Performance meets contractual requirements and exceeds some to the Government’s/Owner’s benefit. The contractual performance of the element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective. 仕事が契約内容と合致

しており、顧客の希望を多少上回る。若干の

不具合も契約の内容に修正し満足な結果であ

る。

A Very Good rating is appropriate when the Contractor successfully performed a significant event that was a benefit to the Government/Owner. There should have been NO significant weaknesses identified.

(S) Satisfactory 満足

Performance meets minimum contractual requirements. The contractual performance of the element contains some minor problems for which corrective actions taken by the contractor are satisfactory. 仕事が最低限の契約内容と合致

している。若干の不具合は修正し特に問題な

い結果である。

A Satisfactory rating is appropriate when there were only minor problems, or major problems that the contractor recovered from without impact to the contract. There should have been NO significant weaknesses identified.

(M) Marginal 問題あり

Performance does not meet some contractual requirements. The contractual performance of the element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions. The contractor's proposed actions appear only marginally effective or were not fully implemented. 仕事が契約内容と合致していな

い。不具合も修正可能か把握できず、深刻な状

態である。業者から提案される方法は効果的と

は言えないし実行されてもいない。

A Marginal is appropriate when a significant event occurred that the contractor had trouble overcoming which impacted the Government/Owner.

(U) Unsatisfactory 不満足、問題あり

Performance does NOT meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element contains serious problem(s) for which the contractor's corrective actions appear ineffective.

仕事が契約内容にほとんど合致しておらず、

不具合の復旧も迅速ではなく、修正も全く効

果的ではない。

An Unsatisfactory rating is appropriate when multiple significant events occurred that the contractor had trouble overcoming and which impacted the Government/Owner. A singular problem, however, could be of such serious magnitude that it alone constitutes an unsatisfactory rating.

(N) Not Applicable 該当なし

No information or did not apply to your contract.

評価材料がない、または該当せず。

Rating will be neither positive nor negative.

b) Ability to meet quality standards specified for technical performance 工事又は提供されているサービスの品質は仕様書で要求されている技術

基準に適合していたか？

E VG S M U N

c) Timeliness/effectiveness of contract problem resolution without extensive customer guidance 詳細な客先の助言無しで問題を適時/適正に解決が

できたか？

E VG S M U N

d) Conformance/compliance to contract requirements, specifications and standards of good workmanship 契約内容、仕様書、規定に沿って業務を遂行できたか？

E VG S M U N

e) Adequacy/effectiveness of quality control program and adherence to contract quality assurance requirements (without adverse effect on performance) 品質管理プログラムは適切かつ有効で実際にそ

の品質管理プログラムに基づいて管理が実施されていたか？

（仕事に悪影響が出ることなく）

E VG S M U N

f) Provided timely resolution of warranty defects (if applicable).

保証期間内における欠陥に対し、適切に対応できたか？（該当

する場合のみ）

E VG S M U N

2. SCHEDULE/TIMELINESS OF PERFORMANCE（期日の遵守） :

a) Developed realistic progress schedules

工事工程表は適切なものであったか？ E VG S M U N

b) Compliance with contract delivery/completion schedules including any significant intermediate milestones. (If liquidated damages were assessed or the schedule was not met, please address below): 契約全体及びその中に含

まれる重要な中間又は完了期限/期日は遵守されていたか？（もし損

害賠償金が発生、または期限が遵守されていなかった場合、詳しく

お書き下さい）

E VG S M U N

c) Rate the contractor’s use of available resources to accomplish tasks identified in the contract 契約を遂行するための業者の資材調達、

活用能力は？

E VG S M U N

3. CUSTOMER SATISFACTION （顧客の満足度）:

a) To what extent were the end users satisfied with the project?

どの程度の顧客満足度か？

E VG S M U N

b) Contractor was reasonable and cooperative in dealing with your staff (including the ability to successfully resolve disagreements/disputes;

responsiveness to administrative reports, businesslike and communication) 業者は御社の担当者に協力的であったか？（ 業者との意見の相 違、論争を有効に解決する能力、及びそれらへの書類での対応、 真摯なコミュニケーション能力）

E VG S M U N

c) To what extent was the contractor cooperative, businesslike, and concerned with the interests of the customer? 業者の協力姿勢、ビジネス上の態

度、顧客の希望を考慮したかどうかについての満足度は？

E VG S M U N

d) Overall customer satisfaction 総合的な顧客満足度は？

E VG S M U N

4. MANAGEMENT/ PERSONNEL/LABOR （人員の管理能力）:

a) Effectiveness of on-site management, including management of subcontractors, suppliers, materials, and/or labor force? 現場と人

員の管理、下請け業者、取引業者、メーカー等との連携能

力は？

E VG S M U N

b) Ability to hire, apply, and retain a qualified workforce to this effort この工事又はサービスを提供できる適任者を雇うことができたか？

E VG S M U N

c) Government Property Control

軍の土地や所有物に対する管理は？ E VG S M U N

d) Knowledge/expertise demonstrated by contractor personnel

専門知識の活用はなされていたか？ E VG S M U N

e) Ability to simultaneously manage multiple projects with multiple disciplines

同時にいく つかの現場を平行して管理できていたか？ E VG S M U N

f) Ability to assimilate and incorporate changes in requirements and/or priority, including planning, execution and response to Government changes 要求の変更に対しての、優先順位の把握、計画、遂行の対応 能力は？

E VG S M U N

g) Effectiveness of overall management (including ability to effectively lead, manage and control the program) 仕事全体の管理は効果的に実施されて

いたか？（計画、管理、指導が 的確に実施されていたか？）

E VG S M U N

5. COST/FINANCIAL MANAGEMENT （資金の管理）:

a) Ability to meet the terms and conditions within the contractually agreed price(s)? 資金面で同意された内容の範囲において契約内容は遵守さ

れたか？

E VG S M U N

b) Contractor proposed innovative alternative methods/processes that reduced cost, improved maintainability or other factors that benefited the client 御社 に利益をもたらす資金削減の提案や、先進的でよりよい方法の提

案はされたか？

E VG S M U N

c) Rate the Contractor’s timeliness and accuracy in submitting monthly invoices with appropriate back-up documentation, monthly progress reports.

月々の支払い請求書は、必要書類を添えて、期限内に提出されていた

か？

E VG S M U N

d) Obtained consent of surety for increases in bonding as work-in-progress increased.

業務の増加において、契約保証人（保証引き受け元）より、保

証の増加に対する承諾書を受諾したか？

Yes No

e) If this is/was a Government contract, has/was this contract been partially or completely terminated for default or convenience or are there any pending terminations? Indicate if show cause or cure notices were issued, or any default action in comment section below. この仕事が、公共または米軍政

府との契約の場合、部分的に、又は全 体が業者の責任（又はその他

の理由）で解約されたり、又は解約手続 き中であるか？ もし、上記の解約等に関連する警告文書等がすでに業者に出されて

いる、もしくは何らかの解約手続きが進行中であれば、詳しくお書

き下さい。

Yes No

f) Have there been any indications that the contractor has had any financial problems? If yes, please explain below. この仕事を行った業者が財政/ 金融 等の問題を抱えているような兆候は あったか？

もしあれば、下記に詳しくお書き下さい。

Yes No

6. SAFETY/SECURITY（安全面）:

a) To what extent was the contractor able to maintain an environment of safety, adhere to its approved safety plan, and respond to safety issues?

(Includes: following the users rules, regulations, and requirements regarding housekeeping, safety, correction of noted deficiencies, etc.)

どの程度業者は承認された安全計画に基づく 安全の管理ができていた （ 御社との取り決めや法律、現場の特徴、安全、不具合に対す る対応等を含む）

E VG S M U N

b) Contractor complied with all security requirements for the project and personnel security requirements.

人員に対する安全は確実に守られていたか？

E VG S M U N

7. GENERAL （総合評価）:

a) Ability to successfully respond to emergency and/or surge situations (including notifying COR, PM or Contracting Officer in a timely manner regarding urgent contractual issues). 緊急時の仕事又は仕事量の急増

に十分に対応できたか？（軍の担当各 所への適切なタイミング

での連絡を含む）

E VG S M U N

b) Compliance with contractual terms/provisions (explain if specific issues) 総合的に契約内容は遵守されていたと思うか？（ そうでない場

合、詳しく お書き下さい）

E VG S M U N

c) Would you hire or work with this company/firm again? (If no, please explain below)

この業者をまた使いたいと思うか？（ そうでない場合、詳しく お書き下さい） Yes No

d) In summary, provide an overall rating for the work performed by this contractor. この仕事を行った業者の総合判定。 E VG S M U N

Please provide responses to the questions above (if applicable) and/or additional remarks.

Furthermore, please provide a brief narrative addressing specific strengths, weaknesses, deficiencies, or other comments which may assist our office in evaluating performance risk (please attach additional pages if necessary (2 max):

上記の設問にお答えになり、下記に文章にて業者の長所、短所、欠点など、業者の選定に

役立つコ メントがあればお書き下さい。